OXFORDSHIRE CHILDREN’S DIABETES SERVICE
Children’s Hospital, Oxford OX3 9DU
Horton Hospital, Banbury OX16 9AL
SICK DAY RULES FOR CHILDREN WITH DIABETES
ON TWO OR THREE TIMES DAILY INSULIN REGIMES
When you are ill your body needs more energy to fight the infection.
Glucose is released from your body stores to do this, so the blood glucose tends to go up
even if you are not eating.
This means that you need more insulin than usual when you are ill.
If you do not give enough insulin then your body cannot use the extra glucose so will start to
break down fat for energy.
When fat is broken down, this produces ketones.
KETONES ARE VERY DANGEROUS.
Ketones are acids which can quickly make you feel very unwell and can make you vomit.
They can make you feel breathless. If you do not get rid of the ketones, you can become
extremely unwell and would need urgent hospital treatment (diabetic ketoacidosis (DKA)).
Ketones can still be produced when you are ill even when your blood glucose is low.
Therefore:
Never stop your insulin even if you are not eating
Always check for ketones if you feel unwell regardless of your
blood glucose level
Please email any comments you may have about this document to: Mary.Cheeseman@ouh.nhs.uk
Paediatric Diabetes Team, May 2013
Review May 2016
2
NEVER STOP YOUR INSULIN
ALWAYS CHECK FOR KETONES REGARDLESS OF BLOOD GLUCOSE
CHECK BLOOD KETONES
Blood Ketones Less than 1.0
Blood glucose
less than 6
Blood glucose
6-15
Give ¾ of your
usual insulin
dose
Usual insulin
at usual
time
If not eating, take
frequent small
sugary drinks, or
Glucogel
Blood glucose
more than 15
Usual correction
dose + usual
insulin at usual
time
Frequent
sugar-free
drinks
Blood Ketones 1.0 – 2.9
Blood Ketones 3.0 or more
Usual insulin at usual time
+ EXTRA INSULIN NOW
(see table)
Usual insulin at usual time
+ EXTRA INSULIN NOW
(see table)
EXTRA INSULIN
Weight
NovoRapid
(Kgs)
dose (units)
10
1
20
2
30
3
40
4
50
5
60
6
70
7
80
8
90
9
EXTRA INSULIN
Weight
NovoRapid
(Kgs)
dose (units)
10
2
20
4
30
6
40
8
50
10
60
12
70
14
80
16
90
18
Blood Glucose less than 6
Blood Glucose more than 6
Frequent small sugary drinks or
Glucogel
Glucogel if
necessary
Frequent sugar-free drinks
Check blood ketones and glucose every
2 hours. Repeat process again
CONTACT TEAM IF:
Increasingly unwell
Ketones more than 3 or persist for more than 6 hours
Vomits more than twice
You have to give a second extra dose of insulin
Unable to maintain Blood Glucose above 4
Worried for any reason
Phone number: (01865) 228736 / 228737 / 234584 (nurses)
or 01865 741166 and ask for bleep 1775
or out-of-hours: 07823 533466 and, if no reply, phone:
01865 741166 and ask for bleep 1392 to speak to the paediatric
registrar.